Just over half of patients recovering from a traumatic brain injury developed major depression within a year, a single-center study showed.

Action Points

Explain to interested patients that the results of this single-center study do not necessarily apply to other populations of patients with traumatic brain injuries.

Just over half of patients recovering from a traumatic brain injury (53.1%) developed major depression within a year, a single-center study showed.

That's about 7.9 times higher than the 6.7% expected in the general population and higher than previous estimates of 12% to 42% for patients with traumatic brain injury, according to Charles Bombardier, PhD, of Harborview Medical Center and the University of Washington in Seattle, and colleagues.

The findings were reported in the May 19 theme issue on mental health from the Journal of the American Medical Association.

Joseph Fink, PhD, a neuropsychologist at the University of Chicago, told MedPage Today that the rate Bombardier and colleagues found is likely accurate.

"Because of the methodology that they used and how well they controlled a lot of the extraneous variables in the study, it really helps us be very confident that this is an accurate rate of major depression in this population," said Fink, who was not involved in the study.

Despite the frequency of depression in patients with traumatic brain injury, only 44% received either antidepressants or counseling during the study.

"Because major depressive disorder after traumatic brain injury is an invisible disorder within an often invisible injury," Bombardier and colleagues wrote, "aggressive efforts are needed to educate clinicians about the importance of [the disorder] in this population, to promote integrated systems of detection and multidisciplinary care, and to conduct intervention studies aimed at overcoming multiple barriers to effective treatment."

The study evaluated patients as part of the recruitment phase of a clinical trial looking at the efficacy of sertraline for major depressive disorder after traumatic brain injury. The trial has been completed but the data analysis is ongoing.

Of the patients approached for the study at Harborview, a level 1 trauma center, 559 -- or 52% -- agreed and were followed up nine times in the first year after their accident. All had complicated mild-to-severe traumatic brain injury, mostly from car accidents.

Major depression was diagnosed using the Patient Health Questionnaire depression and anxiety module at each assessment. The European Quality of Life measure was used at the one-year assessment.

Overall, 15.7% of the patients were depressed at the time of injury and another 26.8% had been depressed in the past but not at the time of injury.

More than half (53.1%) met criteria for major depressive disorder at least once in the year after their injury, with 27% screening positive at only one assessment and 36% screening positive for six or more months.

In a multivariate analysis, the risk of a positive screening for major depression was associated with the following:

Major depression at the time of injury (risk ratio 1.62, 95% CI 1.37 to 1.91)

History of major depression before the injury (RR 1.54, 95% CI 1.31 to 1.82)

Age 60 and older versus 18 to 29 (RR 0.61, 95% CI 0.44 to 0.83)

Lifetime alcohol dependence (RR 1.34, 95% CI 1.14 to 1.57)

Women had a greater risk of major depression in an analysis that excluded patients who were depressed at the time of the injury (RR 1.27, 95% CI 1.07 to 1.52).

Patients of both genders who had major depression at some point during follow-up were significantly more likely to report comorbid anxiety disorders (60% versus 7%; RR 8.77, 95% CI 5.56 to 13.83).

Major depression was also an independent predictor of lower health-related quality of life at one year, particularly related to mobility, performance of usual activities, pain and discomfort, and role functioning.

The researchers acknowledged some limitations of the study, including the use of a less-traditional tool for diagnosing major depression, the use of patients at a single center that has high proportions of Medicaid patients and limited ethnic/racial diversity, the low recruitment rate, and the limited generalizability of the findings to patients with uncomplicated mild traumatic brain injury, who comprise the majority of those who sustain traumatic brain injury.

The study was supported by the National Center for Medical Rehabilitation Research, the National Institute of Child Health and Human Development, and the NIH. Pfizer supplied masked sertraline and placebo for the controlled trial.